Can Family Override an Advance Care Directive in Victoria?
No — Family Cannot Override a Valid Instructional Directive
Under Victoria's Medical Treatment Planning and Decisions Act 2016, a properly executed advance care directive containing an instructional directive is legally binding on health practitioners. Family members have no legal authority to override it, regardless of their relationship to the patient.
This is one of the defining features of Victoria's framework. If you've documented a binding refusal of CPR, and your adult child arrives at the hospital insisting that "Mum would have wanted everything done," the treating clinician is legally required to follow your written instruction — not your child's verbal request.
The binding authority of an instructional directive sits above both family wishes and the clinical team's judgement. That's by design: the 2016 Act was created specifically to prevent others from substituting their preferences for yours when you can no longer speak for yourself.
What Family Can Do
While family members can't override an instructional directive, they do play a role in several scenarios:
When no ACD exists. If you haven't created an advance care directive and you lose capacity, the statutory hierarchy kicks in. The treating clinician must identify the first willing and available person on the list: your formally appointed MTDM, then a VCAT-appointed guardian, then your spouse or domestic partner, then your primary unpaid carer, then your oldest adult child, and so on. That person makes treatment decisions on your behalf.
When the ACD contains only values directives. Values directives — statements about your priorities, quality of life preferences, and what outcomes you'd find unacceptable — guide decision-making but aren't binding in the same direct way as instructional directives. Your MTDM (or the next person in the hierarchy) interprets your values and makes decisions accordingly. This is where family input becomes relevant, because interpretation involves judgement.
When the ACD doesn't cover the specific situation. If you're facing a medical scenario your instructional directives don't address, the MTDM or statutory decision-maker steps in to fill the gap. They should make decisions consistent with your known values, but there's more room for discussion and, potentially, disagreement.
When Families Disagree With Each Other
The statutory hierarchy is linear, not democratic. Medical decisions are made by the single highest-ranked available person — not by family consensus. If your spouse and your adult child disagree about a treatment decision, your spouse's view prevails because they sit higher in the hierarchy.
This can create intense conflict, particularly in blended families where step-parents and biological children may have fundamentally different views about the patient's care. Common friction points:
- Estranged spouses who are still legally married but haven't had contact in years may technically outrank adult children who have been the primary carers.
- De facto partners who sit at the top of the hierarchy but must prove a "close and continuing relationship" to the clinical team — a requirement that same-sex and unmarried partners sometimes find difficult to satisfy during a crisis.
- Multiple adult children who disagree among themselves. Only the oldest with a close and continuing relationship is recognised under the hierarchy — but "close and continuing relationship" can itself be contested.
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How to Prevent Family Override Disputes
The most effective protection is a combination of clear documents and explicit communication:
Appoint a Medical Treatment Decision Maker. A formally appointed MTDM sits above the entire family hierarchy. When you choose your MTDM, you're deciding who makes the call — removing the question of which family member has authority.
Use instructional directives for non-negotiable decisions. If there are treatments you definitely refuse or definitely consent to, write them as instructional directives. These aren't subject to interpretation or family debate.
Have the conversation before the crisis. Discussing your medical wishes with your family while you have capacity doesn't give them legal authority to change those wishes later, but it reduces the shock and resistance that drive override attempts. When family members understand why you've made specific choices, they're far less likely to challenge the directive.
Document values clearly. For decisions that will require your MTDM's judgement (situations not covered by instructional directives), a detailed values directive gives them a framework — and gives other family members evidence that the MTDM's decision aligns with what you actually wanted.
What Happens When Family Pressures the Clinical Team
In reality, some families do pressure hospital staff to ignore directives. When the family at the bedside is distressed and vocal, clinical teams face an emotionally charged situation that the strict legal framework doesn't fully prepare them for.
Victorian hospitals should have advance care planning coordinators and clinical ethics committees to support clinicians in these situations. If a family member is demanding treatment that contradicts a valid ACD, the treating clinician's legal obligation is clear — follow the directive. The ethics committee and hospital legal team can provide institutional support for that decision.
If a family member genuinely believes the ACD is invalid (signed without capacity, improperly witnessed, or fraudulently obtained), their recourse is to apply to VCAT for a guardianship order. They cannot simply instruct the hospital to ignore the document.
Planning for Difficult Family Dynamics
The Victoria Advance Directive & Living Will Kit includes a family conversation planner and a values documentation framework designed to reduce conflict. When your directive is clear, your MTDM is explicitly appointed, and your family understands your reasoning, the question of override rarely arises.
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